Will Fixing Nose Tip Also Narrow Nostril Flare?

Question

I have a bulbous tip and my nostrils are flared a little more than I would like (especially when I smile). Apart from that, I like my nose.

	I am considering having tip refinement, but I would also like to have my nostrils narrowed. I consulted a surgeon and he said that I do not need to have alar base reduction. He said that by removing the tip, my nostril width would also decrease. Is this really true? I can't see it myself.

Eric M. Joseph, MD · Answer

You can have your tip narrowed, but this will only decrease the width of your nostrils if your surgeon adds projection to your tip. That means, your nostrils could narrow if you have your tip projected out further from your face;  this is usually accomplished with a cartilage graft (columella strut). Some techniques that are used to narrow your tip could de-project your nose, and make the nostril width wider.
In my hands, most patients with wide nostrils require an inconspicuous alar base resection that heals very well and is commonly performed at the time of Rhinoplasty.
Feel free to post / email me a full face, frontal photo, and I'll be glad to give you my thoughts.
Best regards.

C. Spencer Cochran, MD · Answer

Nostril reduction surgery (called Alarplasty / Alar Base Reduction) is a procedure that can narrow the width of the nostril base, decrease the amount of nostril flaring, and/or decrease the size of the nostrils. It is important to realize that the smile muscles can pull the base of the nose up and outward even if an alar base reduction is performed and the flaring may not totally be corrected.
Alar base reduction can be performed alone or in conjunction with a rhinoplasty. The appearance of a "bulbous tip" most commonly arises from the shape of the underlying cartilages. If this is the case, the lower lateral cartilages (tip cartilages) can be trimmed and reshaped either with sutures or with grafts to relieve the excess curvature. Sometimes, reshaping the tip makes the nostril sidewalls straighter and can help alleviate nostril flare.
To get a better understanding of what your nose would look like after surgery, your prospective rhinoplasty surgeon should be able to show you before and after computer simulations. Many rhinoplasty surgeons use computer imaging, and recently 3D rhinoplasty imaging has become available (see link below).

Michael A. Persky, MD · Answer

Hi SidSid,
Alar base reduction needs to be considered and planned for whenever a rhinoplasty is performed to narrow the tip.  Once all other modifications of the nose are done, the alar base and flare need to be re-evaluated.  It is the last procedure performed in the operation.
Sometimes the modifications of the tip are enough so that alar base reduction is not necessary. 
Last week I planned an alar reduction, but at the completion of the nasal surgery found that the nostrils had a nice shape, without flare, therefore did not reduce the ala.
Like snowflakes, every nose is different.  Rhinoplasty surgeons need to have a plan going into surgery, but sometimes as the operation evolves, the plan changes as well.
Choose your rhinoplasty surgeon carefully.  Be well.
Dr. P

Toby Mayer, MD · Answer

Usually we have to take a wedge out of the nostril base to give a result that you would be satisfied with. See an experienced rhinoplasty surgeon for a second opinion.

David Shafer, MD, FACS · Answer

I would really warn against "a-la-carte" rhinoplasty. Either you are having a rhinoplasty or you are not. Many patients come in and say I just want this or I just want that. It is very easy to say, but in reality, the nose is a very complex operation and it is a mistake to think that you can just operate on one area without affecting the other components of the nose. Find a surgeon who you trust and who you feel comfortable talking about your expectations from surgery. Good luck.

Ira D. Papel, MD · Answer

Altering the shape of the nasal tip may reduce the flaring (outward curve) of the nostrils, depending upon the techniques used. This may be done intentionally by the surgeon, or be an unwanted side effect in some circumstances.
Alar base resection (also known as wedge resections) can narrow the base of the nose and reduce flaring when indicated. 
Only an experienced rhinoplasty surgeon can predict the proper techniques and outcomes for you.

William Portuese, MD · Answer

The bulbousness part of the tip can be reduced by removing a portion of the nasal tip and suturing the remainder of the tip cartilages together to refine the nose. A nasoplasty can also be done to narrow the nostrils. The nostril base width will not decrease by making the tip itself smaller.

Joseph M. Perlman, MD · Answer

Depending on the shape of your tip and the shape of your nasal ala, narrowing the tip may give you the result that you are looking for ; however, tip rhinoplasty and ala revision should be viewed as two separate processes both in evaluating the nose and in determining the final outcome. If the base of the nasal ala is wide, then narrowing the tip itself will probably not narrow the base. There are procedures that narrow the base by narrowing the base of the collumela ,which is the skin and soft tissue between the two nostrils that extends from the tip of the nose down to the lip. This would in effect, narrow the whole base of the nose without affecting the shape of the ala.

	If the Alar shape (nostril shape) is a concern to you, you should speak with your physician about how refining the tip itself will affect the nostril shape. Some patients require an Alar wedge resection at the base of the nostril or even repositioning or revision of the cartilage which forms the rim of the nostril

Steven Wallach, MD · Answer

A bulbous tip can be treated by refining the tip with tip sutures and possibly removing some cartilage. The flare and/or width will not improve significantly without performing a procedure on the nostrils.

Peter E. Johnson, MD · Answer

I believe that a flare of the nostril can improve with tip shaping. If the tip of the nose is very pronounced or 'bulbous' because of thick supporting cartilages the nostril shape can  be changed, in fact is most often changed, as the tip is shaped. Your surgeon is probably correct if his assessment is that a direct reduction of the ala (nostril rim) need not be completed.
Rhinoplasty is not a single operation. It is an entire constellation of techniques which can be applied to any given situation. With the right combination of skill and judgment an experienced nasal surgeon should be able to achieve consistent results pleasing most patients most of the time. If you need to, spend additional time with your surgeon and provide pictures of what you hope to look like, or look closer to, after your procedure. The better your surgeon knows and understands your concerns, the better your experience will become.
Best of luck,
peterejohnsonmd

Will Fixing Nose Tip Also Narrow Nostril Flare?

Answers (11)

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